Whole-genome sequencing in the investigation of recurrent invasive group A streptococcus outbreaks in a maternity unit.
Adult
Cluster Analysis
Disease Outbreaks
Disease Transmission, Infectious
Female
Genotype
Health Personnel
Hospitals, Maternity
Humans
Infant
Infant, Newborn
Molecular Epidemiology
Molecular Typing
Mothers
Polymorphism, Single Nucleotide
Streptococcal Infections
/ epidemiology
Streptococcus pyogenes
/ classification
Whole Genome Sequencing
Maternity
Streptococcus spp.
Whole-genome sequencing
iGAS
Journal
The Journal of hospital infection
ISSN: 1532-2939
Titre abrégé: J Hosp Infect
Pays: England
ID NLM: 8007166
Informations de publication
Date de publication:
Mar 2019
Mar 2019
Historique:
received:
05
06
2017
accepted:
16
03
2018
pubmed:
27
3
2018
medline:
19
3
2019
entrez:
27
3
2018
Statut:
ppublish
Résumé
The clinical manifestations of group A streptococcus (GAS) (Streptococcus pyogenes) are diverse, ranging from asymptomatic colonization to devastating invasive disease. Maternity-related clusters of invasive GAS (iGAS) infection are complex to investigate and control, especially if recurrent. To investigate three episodes of emm 75 GAS/iGAS infection in maternity patients at one hospital site over a four-year period (two with monophyletic ancestry). The episodes are described, together with whole-genome sequence (WGS) isolate analyses. Single nucleotide polymorphism differences were compared with contemporaneous emm 75 genomes. Over the four-year study period, seven mothers had emm 75 GAS/iGAS and one mother had emm 3 iGAS (in year 4) (subsequently discounted as linked). Three (clinical/screening samples) of the seven babies of emm-75-positive mothers and three screened healthcare workers were positive for emm 75 GAS. WGS similarity suggested a shared ancestral lineage and a common source transmission, but directionality of transmission cannot be inferred. However, the findings indicate that persistence of a particular clone in a given setting may be long term. Occupational health procedures were enhanced, staff were screened, and antibiotic therapy was provided to GAS-positive staff and patients. The definitive source of infection could not be identified, although staff-patient transmission was the most likely route. The pattern of clonal GAS transmission over the four-year study period suggests that long-term persistence of GAS may have occurred.
Sections du résumé
BACKGROUND
BACKGROUND
The clinical manifestations of group A streptococcus (GAS) (Streptococcus pyogenes) are diverse, ranging from asymptomatic colonization to devastating invasive disease. Maternity-related clusters of invasive GAS (iGAS) infection are complex to investigate and control, especially if recurrent.
AIM
OBJECTIVE
To investigate three episodes of emm 75 GAS/iGAS infection in maternity patients at one hospital site over a four-year period (two with monophyletic ancestry).
METHODS
METHODS
The episodes are described, together with whole-genome sequence (WGS) isolate analyses. Single nucleotide polymorphism differences were compared with contemporaneous emm 75 genomes.
FINDINGS
RESULTS
Over the four-year study period, seven mothers had emm 75 GAS/iGAS and one mother had emm 3 iGAS (in year 4) (subsequently discounted as linked). Three (clinical/screening samples) of the seven babies of emm-75-positive mothers and three screened healthcare workers were positive for emm 75 GAS. WGS similarity suggested a shared ancestral lineage and a common source transmission, but directionality of transmission cannot be inferred. However, the findings indicate that persistence of a particular clone in a given setting may be long term.
CONCLUSIONS
CONCLUSIONS
Occupational health procedures were enhanced, staff were screened, and antibiotic therapy was provided to GAS-positive staff and patients. The definitive source of infection could not be identified, although staff-patient transmission was the most likely route. The pattern of clonal GAS transmission over the four-year study period suggests that long-term persistence of GAS may have occurred.
Identifiants
pubmed: 29577990
pii: S0195-6701(18)30169-5
doi: 10.1016/j.jhin.2018.03.018
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
320-326Informations de copyright
Copyright © 2018. Published by Elsevier Ltd.